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ATTENDEE REGISTRATION FORM



******Advance Registration*****

ATTENDEE INFORMATION

E-mail Address:*

A valid email address is required to register and attend FIME 2014. E-mail addresses are not used for any other purposes.

First Name:*
Last Name:*
Company:
Job Title
Address Line 1:*
Address Line 2:
City:*
Province:
State:*
Postal /Zip Code:*
Country:*
Country Code:
Area Code:*
Phone Number:*
Fax Country Code:
Fax Area Code:
Fax Number:



ATTENDEE PROFILE

Business Category (check one that best describes)

Hospital Imaging Center
Integrated Medical Delivery Network Group Purchasing Organization
Private Medical Practice Medical Laboratory
HME/DME Provider Insurance Services HMO/MCO/PPO
Distributor of Medical Products Manufacturer - Medical Products
Pharmacy Sub-Acute Care/ Nursing Services
Long Term Care Facility Academic Institution
Financial Services Government Agency
Press Technology Provider EHR/EMS/PHR/PACS/RIS
Other:

Position/ Title (check one that best describes)

Owner/President/CEO General Manager
Physician Director
Purchasing Manager Clinical Engineer
Imaging Equipment Specialist Biomedical Engineer
Nurse Marketing Manager
Operations Manager Sales Manager
IT Government Official
Professor

Medical Product/ Service Interests (check all that apply)

MRI/Radiology/Ultrasound Surgical Equipment
Disposable Medical Products Home /Durable Medical Equipment
Patient Monitors Anesthesia Machines
Surgical Supplies Surgical Instruments
Pharmaceutical Products Autoclaves & Sterilizers
Pharmacy/e-Prescribing Endoscopy Equipment
Nuclear Imaging Practice Management Systems
Operating Room Equipment Rehabilitation Products
Ophthalmology Equipment Respiratory Equipment
Orthotics/Prosthetics Infection Control
Medical Furniture Lab Equipment
Medical Gas Generation PACS/Radiology/Enterprise Image Mgmt

For questions about registration, email: info@fimeshow.com


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